Phacoemulsification In Angle-closure Glaucoma Research Articles

Kahook Dual Blade Excisional Goniotomy and Goniosynechialysis Combined With Phacoemulsification for Angle-closure Glaucoma: 6-Month Results.

The purpose of this study was to characterize reductions in intraocular pressure (IOP) and the need for IOP-lowering medications following phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy in eyes with angle-closure glaucoma and cataract. In this retrospective, interventional case series, preoperative, operative, and postoperative data were collected through 6 months of follow-up from 42 eyes of 24 subjects. Outcomes included mean IOP reduction, reduction in IOP-lowering medications, and the proportion of patients achieving IOP reduction ≥20%, IOP≤18 mm Hg, and reduction of ≥1 medication. Preoperatively, mean (SE) IOP was 25.5 (0.7) mm Hg and the mean number of IOP-lowering medications used was 2.3 (0.1) per eye. Through 6 months of follow-up, mean IOP reductions of 10.1 to 12.8 mm Hg (38.4% to 49.5%; P<0.0001) and mean IOP medication reductions of -2.2 to -2.3 (91.7% to 98.4%; P<0.0001) were seen. At month 6, 92.9% of eyes (39/42) achieved IOP≤18 mm Hg, 100% (42/42) achieved IOP reduction of ≥20%, 100% (42/42) required ≥1 fewer medications for IOP control, and 85.7% (36/42) were medication free. Phacoemulsification combined with Kahook Dual Blade-assisted goniosynechialysis and excisional goniotomy safely provides statistically and clinically meaningful reductions in both IOP and the need for IOP-lowering medications in eyes with angle-closure glaucoma.

The clinical effect of miniature glaucoma drainage device implantation combined with phacoemulsification for angle-closure glaucoma with cataract

Objective To observe the treatment effect of Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation for the primary angle-closure glaucoma (PACG) with cataract. Methods Fifty-five eyes of 54 cases of PACG with cataract were selected, and they were randomly devided into clinical trail group(30 eyes of 30 cases) and control group (25 eyes of 24 cases). The clinical trail group was treated with Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation. The control group was treated with trabeculectomy combined with phacoemulsification and intraocular lens implantation. The visual acuity, intraocular pressure (IOP), corneal endothelium and central anterior chamber depth (ACD) were recorded and compared. Results At the last review of trail group after operation, the visual acuity (log MAR) was (0.47±0.31), which was better than the preoperative visual acuity (0.75±0.63)(P=0.002). The postoperative IOP in the clinical trail group decreased compared with the preoperative one (P<0.05). The ACD of the clinical trail group and the control group obviously increased after operation, and the difference in ACD between the two groups after operation was not statistically significant (P=0.451). The difference in corneal endothelial density between preoperation and postoperation in the clinical trail group was not statistically significant (P=0.162). The success rates of the clinical trail group and the control group were 96.67% and 92.00% respectively 6 months after surgery, and the difference was not statistically significant (P=0.585). The complication rate after operation of the clinical trail group (3.33%) was lower than that of the control group (24.00%)(P=0.022). Conclusion The operation of Ex-PRESS miniature glaucoma drainage device implantation combined with phacoemulsification and intraocular lens implantation, which can reduce IOP and improve visual acuity evidently with less complications, is a safe and effective combined operation for glaucoma with cataract. Key words: Glaucoma, angle-closure, primary; Cataract; Trabeculectomy; Phacoemulsification, aspiration; Drainage implant, glaucoma, miniature(Ex-PRESS)

Role of phacoemulsification in angle closure glaucoma.

Cataract or clear Lens extraction has been suggested as a treatment option for different spectrums of primary angle closure diseases. It might reduce the risk of progression of angle closure and/or glaucoma by helping to open the angle and control the intraocular pressure (IOP). Conventionally, medically uncontrolled primary angle closure glaucoma was treated with trabeculectomy or phacotrabeculectomy and acute primary angle closure was treated with laser peripheral iridotomy. However, recent randomized controlled trials have demonstrated greater promise of phacoemulsification cataract surgery alone for control of the IOP. In this report we review the current literature to evaluate the impact of cataract surgery upon preventing and controlling primary angle closure diseases.

Phacoemulsification for angle-closure glaucoma with cataract

Objective To investigate the therapeutic effect of phaeoemulsification for angle-closure glaucoma with cataract. Methods Phacoemulsification with foldable posterior chamber in- traocular（PC-IOL） implantation were performed on 32 eyes （28 cases） with angle-closure glaucoma with cataract. Results After 3 months to 12 months postoperative follow up ,the visual acuity of the 32 eyes was improved significantly after operation; the intraocularpressure of 29 eyes was controlled in 21 mmHg. The mean postoperative anterior chamber depth was increased in all patients. Conclusion phacoemulsification with PC-IOL implantation were effective for angle-closure glaucoma with cataract. Key words: phacoemulsification ; primary angle-closure glaucoma

Phacoemulsification in Angle Closure Glaucoma

Phacoemulsification in angle closure can be challenging. Many factors, including large lens, small pupil and a narrow working space in the anterior chamber, contribute towards an increased level of difficulty. Angle closure eyes are also often associated with increased risk of complications such as malignant glaucoma and suprachoroidal hemorrhage. For the inexperienced or the unsuspecting, phacoemulsification in these eyes can often result in unnecessary and devastating complications, including posterior capsule rupture, dropped nucleus, or suprachoroidal hemorrhage. This chapter therefore aims to identify the surgical challenges presented in eyes with angle closure, and to suggest interventions and surgical techniques that may be useful in ensuring a smooth and uncomplicated surgical course during phacoemulsification. Before we come to this, it is first necessary to look at the aims of and indications for cataract extraction in angle closure.

The clinical study of phacoemulsification for angle-closure glaucoma with cataract

目的 探讨晶状体超声乳化吸出联合后房人工晶状体植入术,治疗白内障合并原发性闭角型青光眼的疗效.方法 本院收治白内障合并原发性闭角型青光眼37例(37眼),术前控制眼压,经视力、眼压、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入.结果 术后随访6～18个月,视力较术前提高,视力》0.5者20眼,占54.05%,22例术后眼压《18 mmHg,另5例用1种降眼压药物眼压控制在18 mmHg以下.结论 晶状体超声乳化后房人工晶状体植人可有效地治疗合并白内障的原发性闭角型青光眼。

Factors Predicting Intraocular Pressure Control After Phacoemulsification in Angle-Closure Glaucoma

To investigate whether the presence of glaucomatous optic neuropathy affects the reduction of intraocular pressure (IOP) after phacoemulsification in postiridotomy eyes with primary narrow angles, and to evaluate the preoperative factors associated with postoperative IOP control in primary angle-closure glaucoma (PACG). Patients with PACG undergoing phacoemulsification were prospectively enrolled and received a complete ophthalmic examination. Diurnal IOP was measured 1 day before and 3 months after surgery. For comparison, patients with primary angle closure or angle closure suspect (PAC/S) undergoing phacoemulsification were also enrolled. Postoperative reduction of IOP was significant in the PACG group (n = 29; P = .001) and in the PAC/S group (n = 28; P<.001), with no significant difference between the groups. The number of glaucoma medications used decreased in both groups (both, P<.001). Multiple regression analysis for the PACG group showed that there was a positive correlation between postoperative IOP and preoperative factors of mean IOP (P = .001) and the anterior chamber depth (P = .03). The reduction of IOP 3 months after phacoemulsification is significant and is similar in extent in postiridotomy eyes with and without glaucomatous optic neuropathy. A higher postoperative IOP in PACG is associated with a higher preoperative IOP and with a deeper preoperative anterior chamber depth.

The clinical study of phacoemulsification for angle-closure glaucoma with cataract

目的 探讨晶状体超声乳化吸出联合后房人工晶状体植入术,治疗白内障合并原发性闭角型青光眼的疗效.方法 2001年3月～2002年12月本院收治白内障合并原发性闭角型青光眼27例.术前控制眼压,经视力检查、前房角镜和裂隙灯显微镜等检查后,均单独采用晶状体超声乳化吸出联合后房人工晶状体植入.结果术后随访6～18月.视力均较术前提高,视力＞0.5者占51.9%.22例术后眼压＜18 mmHg(1 mmHg=0.133kPa),另5例用一种降眼压药物眼压控制在18 mmHg以下.结论超声乳化后房人工晶状体植入可有效地治疗合并白内障的原发性闭角型青光眼。